Hemodialysis at home: when, how and for whom.

In recent years, there has been a small boom of a dialysis technique that remained in oblivion since the 1980s, is home hemodialysis. It consists of carrying out hemodialysis at home, although with some nuances and differences on “classic” dialysis, that of the hospital, which will be discussed below.

History of home hemodialysis

The first thing we will say is that it is not a new technique, but it was already used in the 1970s. In fact, according to some studies in 1973, 30% of patients in the United States were dialyzed by this technique (although obviously neither the machines nor the material had anything to do with the current one). However, during the end of that decade, early 1980, home hemodialysis fell into oblivion, with the emergence of peritoneal dialysis as a technique model at home and considering that the rest of the patients who could not undergo this type of dialysis should perform it at home. the nearest hospital or dialysis center. However, in the past decade, there has been a resurgence of interest in home hemodialysis, since, for example, there were people who wanted to be treated at home,

Currently, the situation is very variable between some countries and others, because although for example, in Australia or New Zealand they represent 20 or 30% of the total number of people who are dialyzed, in other cases as in Portugal, Greece or Russia they do not amount to 1%, according to data from 2013. In Spain, although at the beginning of the current decade the percentage was testimonial, there has been an increase in recent years, although very far from Australians or New Zealanders.

Modalities of home Hemodialysis

Practically from the beginning of the technique, in the 70s two types of home hemodialysis modalities were observed:

A type of long-term dialysis that was usually performed during the hours the person was asleep (6-8 hours). This modality predominated in North America

another type of dialysis shorter than 2-3 hours, but more frequent (5-6 days a week), the most used

there are experiences combining both types, with nocturnal and frequent hemodialysis, such as those performed at the Western Hospital in Toronto (Canada)

Advantages of Home Hemodialysis

In general, both types of modalities have important advantages over conventional hemodialysis performed in the hospital. Let’s think that by cleaning more or more frequently, our blood, we are getting a little closer to the normal functioning of the kidney, with which the benefits will be evident. Among them we will point out:

Improves survival, as some studies have shown.

Improves heart function and prevents thickening of the heart, compared with conventional dialysis.

It improves the elimination of phosphorus, so it does not accumulate in excess, and it is necessary to take fewer pills to reduce it.

Improves the control of anemia.

The person who undergoes this technique perceives a better quality of life and feels that he takes charge of his illness.

Disadvantages of home dialysis

However, like everything in life, this technique also has its weak point and is the problem of infections, which are a little more frequent than those seen in people who go to the hospital to be dialyzed. When the fistula or catheter is used more frequently, the risk of infection increases. It should be noted that when strict hygiene measures are followed, such as putting on masks on the connection and disconnection, washing hands thoroughly, having a very clean room or fourth where the technique is done, the infections decrease a lot. Therefore, the most important thing will be to teach the person who is going to have dialysis to take a good cleaning routine and strict care to avoid contaminating the fistula or the catheter.

Who homes Hemodialysis can be done?

In principle, anyone can perform this technique of dialysis, although some particular circumstances will make it ill-advised in specific cases, such as:

In diabetic people, with very poor control of sugar figures, with very frequent drops and rises may not be indicated, since measures may be necessary to normalize the sugar that can only be applied in the hospital, such as administering sera with glucose, or fast-acting insulins.

Also, in those people who are very unstable during the dialysis session, with tension drops, dizziness, vomiting, cramps … it is better to go to the hospital to be dialyzed, at least while this unstable situation persists.

In those cases of very dependent patients, who due to mobility problems, vision, or any health problem, having dialysis at home, supposes a very important overload for him or the caregivers

In people with frequent problems of fistula or catheter infections

In those cases in which hemodialysis at home supposes a very important stress for the patient, due to fear or insecurity

Therefore, although the benefits of the technique seem obvious, not in all cases is recommended and will have to be individualized case by case. The important thing is that the person who has to opt for a certain type of technique when he is in the phase of advanced renal failure knows that this possibility exists and in what it consists, in order to be able to make an adequate decision.